Your Right to Know

Facing the growing likelihood that Republican legislators will not pass Medicaid expansion this
fall, Gov. John Kasich is preparing for possible implementation of broader coverage without full
legislative approval.

But Sen. Dave Burke, R-Marysville, the point person for Senate Republicans’ caucus on Medicaid
changes, said he will roll out a Medicaid bill next week that will have nothing to do with
expansion. The bill will focus on ways to reduce Medicaid costs, he said.

“I’m focused on the problem in Medicaid — the ever-increasing consumption of the state budget,”
Burke said. “If we can accommodate other services, that’s a discussion.”

Meanwhile, the House plans to introduce as many as a dozen Medicaid-related bills as soon as
next week. A House GOP caucus spokesman said he would be surprised if one was not an expansion
bill, but that alone does not mean that the caucus will support it.

The House bills will focus on controlling costs and lifting people off Medicaid, said Rep. Ron
Amstutz, R-Wooster. “There are going to be a lot of moving parts.”

But while Republican legislators focus on what they call reform, they have resisted Kasich’s
effort to expand Medicaid eligibility to those with incomes of up to 138 percent of the federal
poverty level, covering an estimated 275,000 low-income Ohioans. Starting Jan. 1, the expansion
would be fully funded by the federal government for three years; then, the federal funding would be
reduced to 90 percent. The total federal aid would be an estimated $13 billion over seven
years.

Rather than winning passage of an expansion bill by both legislative chambers, the governor
could seek approval from the seven-member Controlling Board to spend the additional federal
money.

The Controlling Board includes one governor’s appointee, plus a Democrat from each chamber, and
two Republicans from each chamber — meaning that at least one GOP vote is required for approval.
Republican legislative leaders can easily swap their members on the board.

“Funds for any changes to Medicaid require legislative approval, either by legislation or the
Controlling Board, and the administration will be prepared to implement those changes whenever and
however the General Assembly makes them possible,” said Kasich spokesman Rob

Nichols. “We continue to actively consider any and all strategies for getting this done.”

Sen. Bill Coley, R-West Chester, a member of the Controlling Board, hopes the governor holds
off. “Some of the reform ideas are better than what was proposed for Medicaid expansion,” he
said.

Amstutz, who also is a Controlling Board member, said he has “grave concerns” about using the
board to approve Medicaid expansion.

“I’d like to see a legislative solution, and that’s what I’m focused on,” he said. “I’m not
focused on end runs.”

Going to the Controlling Board also would be likely to invite legal challenges. Maurice
Thompson, executive director of the 1851 Center for Constitutional Law and an expansion opponent,
said that “if we think we have a strong (legal) case, we will definitely bring it.”

Burke said his bill will focus on waste and abuse, payment reform, chronic-disease management
and other cost-saving measures. It will look similar to a bill introduced in July by Sen. Capri S.
Cafaro, D-Hubbard, “with more refinement from what we found over the summer,” he said.

Although the bill should have bipartisan support, political potholes remain. Democrats want
expansion and might hesitate to back a bill that does not include it. Some Republicans don’t want a
bill that even looks like it might support expansion.

“This is not priming the pump for the governor, or some back-door collusion thing,” Burke said. “
I don’t care what the governor does with expansion. ... I’m focused on one thing — bending the
cost curve on Medicaid.”